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OBGYN > OBAb: Obstetrical Hemorrhage > Flashcards

OBAb: Obstetrical Hemorrhage Flashcards

1
Q

Cite possible causes of obstetric hemorrhage

A
  1. Uterine atony
  2. Genital tract lacerations
  3. Retained products of conception
  4. Coagulopathy (thrombin)
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2
Q

____ is the single most important cause of maternal death worldwide

A

obstetrical hemorrhage

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3
Q

____ mL estimated blood loss should alter the obstetrician

A

More than 500mL

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4
Q

____ % volume decrease in the postpartum hematocrit is a clinically significant blood loss with vaginal delivery.

A

6%

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5
Q

Causes of obstetrical hemorrhage antepartum

A
  1. Placenta Previa

2. Abruptio placenta

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6
Q

____ refers to the premature separation of a normally implanted placenta

A

Abruptio placenta

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7
Q

What are the risk factors of abruptio placenta?

A
  1. Prior abruption
  2. Thrombophilias
  3. PROM
  4. pre-eclampsia
  5. Multifetal gestation
  6. Hydramnios
  7. Chronic hypertension
  8. Cigaretter smoking
  9. Increased age and parity
  10. uterine myoma
  11. Cocaine use
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8
Q

What are the components of virchow’s triad in abruptio placenta?

A
  1. Vaginal bleeding after 20 weeks
  2. Increased uterine tone
  3. Abdominal pain
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9
Q

What is the characteristic EFM tracing associated with abruptio

A
  1. Recurrent late or variable decelerations
  2. reduced variability
  3. Bradycardia
  4. Sinusoidal pattern
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10
Q

How will you now that there is coagulation defect in clot observation test?

A
  1. Clot does not form within 6 minutes

2. Forms and lyses within 30 minutes

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11
Q

___ uterus also refers to uteroplacental apoplexy

A

Couvelaire uterus

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12
Q

What is the most common cause of DIC in pregnancy?

A

Abruptio placenta

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13
Q

What are the of CS in abruption placenta?

A
  1. Fetal compromise
  2. Severe uterine hypertonus
  3. Life-threatening vaginal bleeding or DIC
  4. Vaginal delivery is no iminent
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14
Q

[Abruptio placeta]

preterm >24 weeks, stable mother, reassuring fetal status

Management?

A
  1. Conservative management (tocolyze)

2. Deliver 37 to 38 weeks

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15
Q

[Abruptio placeta]

preterm >24 weeks, unstable mother, non-reassuring fetal status

Management?

A
  1. Deliver

2. Do not tocolyze

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16
Q

____ placenta implanted in the lower uterine segment of the uterus, presenting ahead of the leading pole of fetus

A

Placenta previa

Classic presentation: painless vaginal bleeding

17
Q

A low-lying placenta is defined as placental edge within ____

A

2cm from the os

Marginalis - approaching the border of the os

18
Q

What are the common risk factors of placenta previa?

A
  1. Maternal age >35
  2. Multiparity
  3. Prior uterine surgery
  4. Recurrent abortions
  5. Smoking
19
Q

When can you do a vaginal delivery in patients with placenta previa?

A

> 35 weeks

  1. Placental edge 2cm away from os
  2. Placental edge within 0-20 mm from os (depends)
20
Q

What are the indications for CS in patients with placenta previa

A
  1. Any degree of overlap after 35 weeks

2. Elective CS in asymptomatic women is not recommended

21
Q

When will you do elective CS for patients with placenta previa

A
  1. <37 weeks
22
Q

When will you do elective CS for patients with placenta accreta

A

<36 weeks

23
Q

What are the risk factors for massive bleeding during CS via previa?

A
  1. advanced maternal age
  2. previous CS
  3. Presence of sponge-like US findings in the cervix
24
Q

___ refers to placental villi are attached to the myometrium

A

Placenta accreta

Attached = Accreta

25
Q

___ refers to placental villi invading the myometrium

A

Placeta increta

INvade = INcreta

26
Q

___ refers to placental villi that penetrate through the myometrium and to ir through the serosa

A

placenta percreta

PEnetrate = PErcreta

27
Q

[Type of accreta]

all lobules attached

A

Total accreta

28
Q

[Type of accreta]

several cotyledons are attached

A

Partial accreta

29
Q

[Type of accreta]

single lobule abnormally attached

A

Focal accreta

30
Q

What are the 2 most important risk factors of placeta accreta?

A
  1. Previa

2. Prior CS delivery

31
Q

Imperfect development of this layer can lead to the firm adherence of placental villi to the myometrium

A

nitabuch layer

32
Q

[Cause of DIC: Extrinsic or Intrinsic pathway]

Rapid process of DIC
Associated with abruptio placenta, amniotic fluid embolism, retained dead fetus, saline-induction abortion

A

Extrinsic

33
Q

[Cause of DIC: Extrinsic or Intrinsic pathway]

Slow process
associated with septic abortion, chorioamniotinis

A

Intrinsic

OBGYN (33 decks)

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